2018 National Youth Tobacco Survey Shows Increase in E-Cigarette Use Among Youth

Key Points

More than 3.6 million middle and high school students were current (past 30 day) e-cigarette users in 2018, a dramatic increase of more than 1.5 million students since last year.

The number of U.S. high school students who reported being current e-cigarette users increased 78% between 2017 and 2018 to 3.05 million (or 20.8%). Numbers among middle school students rose 48% to 570,000 (or 4.9%).

The uptick in e-cigarette use has led overall tobacco product use to increase by 38% among high school students and by 29% among middle school students in the last year, reversing the positive decline seen over the last few years.

The U.S. Food and Drug Administration (FDA) and U.S. Centers for Disease Control and Prevention (CDC) recently released new findings from the National Youth Tobacco Survey (NYTS) showing that more than 3.6 million middle and high school students were current (past 30 day) e-cigarette users in 2018—an increase of more than 1.5 million students since this past year. According to the results published by Cullen et al in Morbidity and Mortality Weekly Report, youth who use e-cigarettes also are using them more frequently and using flavored products more often than last year. The sharp rise in e-cigarette use has resulted in an increase in overall youth tobacco product use, reversing a decline seen in recent years, and is prompting a series of steps by the FDA to curb youth use trends.

Findings of the Survey

According to the findings, the number of U.S. high school students who reported being current e-cigarette users increased 78% between 2017 and 2018 to 3.05 million (or 20.8%). Numbers among middle school students rose 48% to 570,000 (or 4.9%). The study authors suggest the rise in e-cigarette use in the last year is likely due to the recent popularity of certain types of e-cigarettes, such as JUUL. The increased popularity of e-cigarettes among youth raises a number of other health concerns: risk of addiction to nicotine early on in life; potential harm from nicotine exposure to the developing adolescent brain; and exposure to chemicals associated with adverse health effects. In addition, research shows that, compared with nonusers, youth who use e-cigarettes are more likely to transition to conventional cigarettes.

The uptick in e-cigarette use has led overall tobacco product use to increase by 38% among high school students and by 29% among middle school students in the last year, reversing the positive decline seen over the last few years.

Additionally, the survey also shows that high school students who reported being current e-cigarette users also reported using the product more frequently. In the last year, the proportion of those using the product more regularly (on 20 or more of the past 30 days) increased from 20% to 27.7%. The 2018 NYTS also found that among high school e-cigarette users, there was a significant increase in current flavored e-cigarette use within the past year, from 60.9% to 67.8%. Research shows youth and young adults identify flavors as a primary reason for e-cigarette use. Additionally, there is evidence from the Population Assessment of Tobacco and Health (PATH) Study indicating youth who first tried a flavored tobacco product have a higher likelihood of current tobacco use compared to those who first tried an unflavored product.

The study authors concluded, “Sustained implementation of proven population-based strategies, in coordination with the regulation of tobacco products by FDA, is key to reducing all forms of tobacco product use and initiation, including e-cigarettes, among U.S. youths.”